A 72‐year‐old woman underwent an elective mitral valve replacement and tricuspid valve repair for severe mitral regurgitation and moderate tricuspid regurgitation. A 25‐mm tissue mitral Mosaic valve (Medtronic. Inc, Minneapolis, MN, USA) was inserted, and a DeVega‐type annuloplasty repair of the tricuspid valve was performed. During weaning from cardiopulmonary bypass, intra‐operative two‐dimensional (2D) transoesophageal (TOE) imaging revealed intermittent echogenic opacities in the left atrium suggestive of intracardiac air bubbles (Fig. 1a). However, three‐dimensional (3D) TOE imaging revealed these opacities to be transiting the orifice of the prosthetic mitral valve in diastole (Fig. 1b), and their spherical shape more confidently suggested a gaseous composition. Following protracted de‐airing manoeuvres (manual cardiac agitation and systemic hyperoxia), the patient was successfully weaned from cardiopulmonary bypass.
Figure 1.
Transoesophageal echocardiographic (TOE) images obtained during de‐airing manoeuvres following mitral valve replacement and tricuspid valve repair. (a) A two‐dimensional TOE image from a mid‐oesophageal four‐chamber view of the heart showing bubbles in the left atrium (white arrows). (b) A three‐dimensional TOE image showing the bioprosthetic mitral valve in diastole from the left atrial view, with air bubbles (black arrows) visualised in the mitral inflow orifice. https://youtu.be/Dq6maQ2ryYI
Retained intracardiac air frequently occurs after open‐chamber cardiac surgery 1. Air commonly accumulates in the left ventricular apex, the pulmonary veins and along the left side of the interatrial septum 2. Extensive intracardiac air is known to cause myocardial ischaemia secondary to coronary air embolism and has also been linked to postoperative neurologic dysfunction 3. Despite this, the patient suffered no known sequelae and was discharged from the intensive care unit on the first postoperative day. She was discharged home on postoperative day seven without any apparent complications.
Acknowledgements
Published with the written consent of the patient. No external funding or competing interests declared.
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